The Lancet Regional Health - Western Pacific 8 (2021) 100103

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The Lancet Regional Health - Western Pacific

journal homepage: www.elsevier.com/locate/lanwpc

Research paper

One household, two worlds: Differences of perception towards child

marriage among adolescent children and adults in Indonesia ✩
Heribertus Rinto Wibowo a, Muliani Ratnaningsih a,∗, Nicholas J Goodwin a,
Derry Fahrizal Ulum b, Emilie Minnick b
a
Tulodo Indonesia, Indonesia
b
UNICEF Indonesia, Indonesia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Indonesia is eighth in the world in the incidence of child marriage, with South Sulawesi
Received 19 September 2020 province having one of the highest burdens (12.1%) in the country. The study explored the determinants
Revised 4 January 2021
of child marriage in Bone, South Sulawesi, in particular the differences between adolescents and parents.
Accepted 21 January 2021
Available online 5 February 2021 Methods: This is a cross-sectional study using a quantitative survey. A total of 1,004 respondents partici-
pated (500 parents and 504 adolescents aged 13-15 years).
Keywords:
Child marriage Findings: This study found that around one out of four parents or adolescents had perceptions that sup-
Adolescents port determinants of child marriage. A total of 25.8% of parents and 26.0% of adolescents agreed that a
Parents girl is ready for marriage once she starts menstruation. 25.6% of parents and 32.6% of adolescents agreed
Reproductive health that girls aged over 18 who are not married are a burden to their families. Using the U-Mann Whitney ,
Indonesia Kendall’s tau-b, and Pearson’s correlation test, these differences were found to be significant.
Interpretation: Overall, the perceptions of parents and their adolescent children do not greatly differ, with
some notable exceptions. Positive perceptions towards the benefits of child marriage are still prevalent
among both parents and adolescents. This indicates that social norms supporting child marriage are still
strong among these groups. Comprehensive interventions are needed to promote the benefits of marrying
later, based on local cultural contexts and evidence on efficacy.
© 2021 The Author(s). Published by Elsevier Ltd.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Research in Context Panel

power in decision making among girls also means parents
tend to make decisions for their daughters about when and
Evidence before this study whom to marry but they do not fully bear the impact of
those decisions.
The prevalence of child marriage in Indonesia is still high
(10.82%). A large proportion of females are still entering into
child marriage placing young mothers and their adolescents
at significant risk. Several studies explore factors underlying
child marriage practices include limited economic and edu-
cational opportunities, cultural norms, poverty, and parental Added value of this study
concerns with safeguarding their daughters’ virginity. Parents
are primary decision-makers in child marriage. The lack of This study adds value as it is the first in Indonesia to ex-
plore perceptions among parents and adolescents related to
the determinants of child marriage, e.g., socio-economic, ed-
ucation, and culture. This study is one of the first to doc-
✩
ument an intervention that links child marriage with men-
Funding. This study was conducted by Tulodo with funding from UNICEF, as
strual health in Indonesia. The research also adds value to
part of the BERANI Program collaboration with UNFPA, the Indonesian Government,
and the Canadian Government. studies of making decision processes within families and
∗
Corresponding author. communities, particularly on health and social issues.
E-mail address: muli4ni.r@gmail.com (M. Ratnaningsih).

https://doi.org/10.1016/j.lanwpc.2021.100103
2666-6065/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al.
Implications of all the available evidence
Previous evidence has established an understanding of the
determinants of, and pathways to, child marriage in various
contexts. Some of these examine the attitudes of parents and
young people, few compare statistically significant cohorts of
parents and their adolescent children in the same area, with
none from Indonesia. Given the primacy of this relationship,
our study explores perceptions of child marriage and its de-
terminants between adolescents and parents in Bone, South
Sulawesi. By exploring the differences and similarities be-
tween these two groups, we have produced findings that are
being utilised to design tailored interventions and services to
prevent child marriage.
1. Introduction
Child marriage and menstrual health are two significant and in-
terconnected health and human rights concerns in many low- and
middle-income countries, including Indonesia. Around 45% of In-
donesian girls feel unprepared for their first period, and only 16%
of adolescent girls and 9% of adolescent boys know that a woman’s
fertile period is halfway between her periods [1]. The child mar-
riage burden remains too high in Indonesia, especially among fe-
male adolescents, despite positive long-term trends. Since 2008,
there was a 3.85% decrease in the prevalence of child marriage
from 14.67% in 2008 to 10.82% in 2019 [2,3]. The decline occurred
in around three-quarters of provinces, mostly in rural areas. This
continues a longer-term trend in the decline of child marriage in
Indonesia - the risk of marrying before age 18 is less than half of
what it was three decades ago. Based on 2017 data from the Vil-
lage Data System (Sistem Data Desa Kelurahan = SDDK), from the
266,378 children in Bone District, the number of child marriage
cases reached 2,635 cases [2].
A study in Indonesia targeting women aged 20-24 years found
that child marriage has a socio-economic and health-related im-
pact [2,4]. Women who were married under 18 years (13.8%) were
more likely to live in poverty than women who were married
above 18 years (10.1%). They also (58.9%) were more likely to have
higher living expenses than those married above aged 18 years
(52.8%). For the health impact of child marriage, teenage preg-
nancy is correlated with maternal mortality and morbidity. Girls
aged 10–14 years had five times the risk of dying during pregnancy
or childbirth compared to 20-24 years, while this risk doubled in
15-19 years. The mortality rate for mothers under the age of 16 in
middle and low-income countries is even sixfold higher. In Indone-
sia, the percentage of underweight babies born to women who
were married below the age of 18 years was slightly higher (14.9%)
than those born to women who married above 18 years (13.6%).
Those married after the age of 18 years (81.8%) are more likely to
give birth to babies weighing over 2.5 kg compared to those who
are married under 18 years of age (76.3%). In 2015, a UNICEF study
discussed the impact of girls’ limited ability to manage menstrua-
tion in schools, such as reduced participation and performance, ab-
senteeism, and health risks. In 2015, a UNICEF study discussed the
impact of girls’ limited ability to manage menstruation in schools,
such as reduced participation and performance, absenteeism, and
health risks [2,4].
Child marriage has a prominent place in the Sustainable De-
velopment Goals (SDGs), which has placed emphasis on gender
equality and empowerment of women and girls. Target 5.3 aims
to end harmful practices against girls and women, including child
marriage. According to the Convention on the Rights of the Child
(CRC), child marriage is defined as the marriage of a child younger
2
The Lancet Regional Health - Western Pacific 8 (2021) 100103
than 18 years old. According to the Convention on the Rights of the
Child (CRC), child marriage is defined as the marriage of a child
younger than 18 years old [5]. The child marriage rate is defined
as the percentage of ever-married women in Indonesia aged 20 to
24, married before age 18 (calculated by dividing the number of
women of age 20-24 years who were married before the age of
18 by the total number of women aged 20-24 years). The global
burden of child marriage is defined as the number of girls under
age 18 who have already married plus the number of adult women
who were married before age 18. Globally, one in six adolescent
girls between the ages of 15 and 19 years is married or in a union,
and as many as 700 million women were married as child brides
in 2014 [6]. Gender norms, cultural practices, and economic chal-
lenges may be factor that drive child marriage. UNICEF data ranks
Indonesia eighth in the world and second highest in Southeast Asia
in terms of the percentage of marriages in which at least one of
the spouses is under 18 years.
One study found that countries and societies with high gender
inequality (e.g. laws and customs that exclude girls from decision-
making or economic and political rights) are more likely to fea-
ture a high prevalence of child marriage [7]. Girls who marry be-
fore 18 years of age have increased risks of school dropout, gender-
based violence, social isolation, poverty, non-use of contraception,
high fertility, short birth intervals, unintended pregnancy, repro-
ductive morbidities including obstetric fistula, maternal mortality,
poor mental health, sexually-transmitted infections, and HIV/AIDS.
Adolescents of adolescent mothers also face an increased risk of
prematurity, malnutrition, and mortality [4]. Another study re-
ported that early marriage reduces the chances of the woman com-
pleting her education and thereby minimising her chances of earn-
ing a decent livelihood. This leads to a vicious cycle where poverty
and low literacy levels are coupled with religious, social, and cul-
tural influences which lead to a higher prevalence of early mar-
riages [8].
Marriage in Indonesia is regulated by Marriage Law No.1 of
1974. According to section 7, marriage is legal if the female is al-
ready aged 16 years (19 years for men). However, the law also al-
lows marriages to be considered legal if they are carried out ac-
cording to religious belief, known as nikah siri’ (secret marriage).
In September 2019, Law No. 16 was issued to amend the Marriage
Law. The new law raised the age that girls can be married with
parental permission from 16 to 19 years, in line with the age for
boys. Marriages recognised by religious courts or officials are often
later officially recognised by the government. Many people are also
satisfied with merely fulfilling religious or traditional requirements
for marriage. A study found that a large proportion of females are
still entering into child marriage and cohabitation situations in In-
donesia, placing young mothers and their adolescents at significant
risk [9].
Inequality between women and men and gender-based violence
remain serious concerns in Indonesia. To help address this situ-
ation, a program called “BERANI,” or Better Reproductive Health
and Rights for All in Indonesia was launched by UNFPA and UNICEF
in partnership with the Indonesian National Development Planning
Agency (Badan Pembangunan dan Perencanaan Nasional/Bappenas)
and the Government of Canada. The name derives from the In-
donesian word berani, which means courageous. One of BERANI’s
aims is to prevent child marriage and improve menstrual hygiene
management. Bone District, South Sulawesi, was selected as the
site for a pilot project and a baseline study was conducted in
2019. The baseline study found seven main contributing factors to
child marriage in Bone, presented below in order from strongest
to weakest. The first is the siri’ (shame) felt by parents around
their daughter’s unwanted pregnancy. Second, and related, is the
parents’ determination to avoid the fear of their adolescent dat-
ing, which is associated with sexual relations and the risk of un-
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al.
wanted pregnancy - and therefore siri’. A third factor is an obedi-
ence and dependence of (rural) children. The fourth determinant is
economic, when parents can no longer support their children and
believe marrying them will reduce this burden, often also felt by
the adolescents. Related to this is the fifth determinant, which is
education, as adolescents who drop out of school are more likely
to marry younger. A sixth determinant is the role of media as a
channel used to connect young people and promote the benefits of
marriage. The seventh and final determinant is the limited knowl-
edge of the negative impacts of child marriage [10]. Lack of com-
munication on health and relationships between parents and ado-
lescents may push young people to seek other information sources,
such as peers and social media, that may be unreliable or inaccu-
rate [11].
Child marriage and menstrual hygiene issues are connected. In
some countries, parents and communities view a girl’s first men-
strual period as a sign that she is a woman and ready for mar-
riage and motherhood. Some child marriages also happen because
the girl gets pregnant. One reason she becomes pregnant is that
the couple (mostly the boy) didn’t know she had her period, or
what it means. And they didn’t know they can become pregnant
by having sex one time. Menstrual health management (MHM) is
one part of sexual and reproductive health (SRH) that is essential
to enable young women to manage their well-being and reproduc-
tive choices.
The relationship between parent and adolescent is fundamen-
tal to shaping children’s trajectories through adolescence and pro-
vides the considerable potential to improve youth sexual and re-
productive health (SRH). This study explores child marriage-related
perceptions among parents and adolescents particularly percep-
tions related to the determinants of child marriage (e.g., socioe-
conomic factors, culture) including the perception of whether a
girl is ready for marriage once she starts menstruating. This study
also explores whether parents and adolescents have different per-
ceptions of child marriage. Based on some studies, we found that
parents’ decision contributes to child marriage. By exploring the
differences between these two groups, it could be utilised to de-
sign interventions and communication strategy for child marriage
prevention. As we may need different approaches for parents and
adolescents in the child marriage campaign. The study was con-
ducted as a guidance to develop a child marriage prevention strat-
egy consisting of a theory of change, monitoring and evaluation
framework, behaviour change approach, and communication ma-
terials for implementation as part of the BERANI pilot program in
Bone, South Sulawesi.
2. Methods
2.1. Study design and participants
This study used a cross-sectional design, with researchers mak-
ing observations or measurements of variables at a certain time.
The participants consisted of two groups: parents or caregivers in
households with children aged 13-15 years and adolescents aged
13-15 years. The study was conducted in Bone District, one of 24
districts in South Sulawesi, located to the east of the capital city of
the South Sulawesi Province. The total area of 4,559 km2 is divided
into 27 districts/kecamatan with 372 villages/kelurahan. The popu-
lation of Bone Regency in 2018 was 869,016 people spread across
27 sub-districts. The total population in Bone age under 18 years
was 266,737 people. According to data from the Ministry of Ed-
ucation, the total adolescents aged 13-15 years in Bone in 2018
was 40,621 children. The study was conducted in Bone as Bone
is part of South Sulawesi with the prevalence of child marriage in
South Sulawesi was 14.1% higher than the average of child mar-
riage prevalence at the national level (11.2%) in 2018, and in 2019,
3
The Lancet Regional Health - Western Pacific 8 (2021) 100103
the prevalence was 12.1%, still higher than the national average
10.82%.
2.2. Procedures
2.2.1. Adolescent survey sampling
As we compared the differences between boys and girls, the
minimum number of participants for each group was calculated
using Hulley et al’s 2013 method, where N (sample) = 16: (stan-
dardised size effect)2 . The standardised size effect to be used is
0.3, with a confidence interval of 95%, and power (β ) of 80%. Us-
ing this formula, the sample for each group needed was 177 peo-
ple. The total required sample for both boys and girls were 354
adolescents aged 13-15 years. Adding 10% to allow for problems,
the total sample recruited was 389 adolescents, both in and out of
school. Samples were taken from 12 intervention schools in 6 sub-
districts and 4 schools from control areas. We recruited 30 respon-
dents in each school. For the out of schools, we recruited 24 ado-
lescents aged 13-15 years using a purposive sampling method. The
intervention areas were six villages selected by UNICEF as the im-
plementing areas for the BERANI program, while the control areas
were the areas that did not receive the BERANI program in Bone
District, South Sulawesi, Indonesia. For samples selected within the
school, the researcher used simple random sampling from a list of
students aged 13-15 years. For samples selected outside of school,
the researcher used purposive sampling, with the following crite-
ria: (1) male/female adolescents aged 13-15 years and (2) dropping
out of school/not continuing their education.
2.2.2. Parent/caregiver survey sampling
The same sampling method and size for the adolescent sur-
vey was used for the parent/caregiver survey, with a total sam-
ple recruited needed of 389 people. Respondents aged 30 years
and over from 8 villages in Bone who have adolescents aged 13-15
years were recruited. With the help of the village government, we
mapped the households and determined which respondents were
visited by using random techniques. We select one house for ev-
ery 10 houses, and if there were no families with adolescents aged
13-15 years within the 10 houses range, we visited the house next
door until we found those with children aged 13-15 years, ask the
households to join the study, and continued the data collection.
2.2.3. Outcomes
This study will show different perceptions among parents and
adolescents toward child marriage, its determinants, and its im-
pact. The independent variables were demographics: gender, type
of respondents (parent/caregiver vs adolescent), and location. The
dependent variables in this study were the level of perception re-
lated to child marriage and menstrual health. This study also ex-
plored factors that influence parent/caregiver intention to arrange
a marriage for their adolescents. This included adolescent intention
and acceptance to marry early, as well as parent/caregiver efforts
to provide education on health and relationships.
2.2.4. Data collection
For the quantitative study, survey-style interviews of par-
ents/caregivers were conducted by enumerators. There were eight
enumerators with experience in data collection and various edu-
cational backgrounds, some had graduated from universities and
some were university students. For adolescents at school, data
was collected through questionnaires. The questionnaire used pa-
per, whilst for the parent/caregiver survey, data collectors used the
mWater Surveyor App on tablets. The survey took approximately
50–60 minutes to complete. Questionnaires were developed based
on references from several standard questionnaires with modifi-
cation of questions to focus more on the practices of adolescents
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al. The Lancet Regional Health - Western Pacific 8 (2021) 100103

Table 1 Table 2
Sample characteristics of households. Sample characteristics of adolescents.

Sample Characteristics n % Sample Characteristics n %

Sub-district Sub-district
Ajangngale 54 10.8 Ajangngale 63 12.5
Awangpone 58 11.6 Awangpone 63 12.5
Bontocani 62 12.4 Bontocani 63 12.5
Cina 52 10.4 Cina 63 12.5
Libureng 116 23.2 Libureng 63 12.5
Salomekko 32 6.4 Salomekko 63 12.5
Tellusiattingnge 78 15.6 Tellusiattingnge 63 12.5
Ulaweng 48 9.6 Ulaweng 63 12.5
Gender Gender
Male 84 16.8 Boys 254 50.4
Female 416 83.2 Girls 250 49.6
Education of parents/caregivers Grade of schools
No school/out of school 15 3.0 Grade VII 80 15.9
Graduated from Madrasah Ibtidaiyah (MI) 1 0.1 Grade VIII 176 34.9
Graduated from Madrasah Tsanawiyah (MTs) 14 2.8 Grade IX 224 44.4
Graduated from Madrasah Aliyah (MA) 5 1.0 Not schools/out of schools 24 4.8
Graduated from Elementary School 192 38.4
Graduated from Junior High School 107 21.4
Graduated from High School 85 17.0
Not complete Madrasah Ibtidaiyah (MI) 1 0.2 2.2.6. Role of the funding source
Not complete Madrasah Tsanawiyah (MTs) 1 0.2 UNICEF and UNFPA in partnership with the Indonesian Govern-
Not complete Madrasah Aliyah (MA) 0 0
ment, and the Canadian Government launched the BERANI (Better
Not complete Elementary School (SD) 31 6.2
Not complete Junior High School (SMP) 11 2.2
Reproductive Health and Rights for All in Indonesia) in 2018. One
Not complete High School 8 1.6 of the components in the BERANI program is the baseline study in
University or College 29 5.8 Bone. This study is part of the baseline study, as we explore fur-
Status of parents in the household ther the findings to address the research questions. The funding
Mother/main caregiver 361 72.2
used to manage the study including for the data collection with
Head of the family 100 20.0
Another adult male 1 0.2 enumerators and data analysis.
Other adult women/child guardians 38 7.6
3. Results

and parents/caregivers around child marriage and menstrual health
issues. Data collection was carried out by the main researcher
and assisted by eight enumerators. Before data collection, training
for the enumerators and pilot testing was conducted. The train-
ing aimed to ensure the uniformity of the data collection and
so the enumerators followed the research protocol. The pilot test
was conducted to analyze the level of understanding of the par-
ticipants of the survey questions and to improve the interviews.
Pilot testing with thirty selected households and thirty students
was conducted before the data collection. Ethical Clearance was
obtained from the University of Indonesia’s Center for Health Re-
search (No.256/UN2.F10/PPM.00.02/2019).
2.2.5. Statistical analysis
SPSS 22.0 for PC was used to analyze quantitative data. To an-
alyze demographic data, such as gender, the use of media, and
technology, descriptive statistics were used. To answer the research
question, inferential statistics were used. The questions of attitudes
related to child marriage were explored as the dependent variables
in this study were taken from the Child Marriage Acceptability In-
dex (CMAI) developed by Plan International and standard ques-
tionnaire from UNICEF related to child marriage. The responses
were arranged along a 7-level Likert scale consisting of: strongly
disagree (1), disagree (2), slightly disagree (3), neither disagree
nor agree (4), slightly agree (5), agree (6), and strongly agree (7).
For further analyses, we classified the responses above into two
categories: (1) agree category (strongly agree/agree/slightly agree)
and (2) disagree category (strongly disagree/disagree/slightly dis-
agree). As the nature of data is ordinal, we used the U-Mann
Whitney Test to analyze the differences in perception between
parents/caregivers and adolescents. To analyze the association be-
tween attitudes and gender, type of respondents, and locations, we
used Kendall’s tau-b for Likert-type items and Pearson’s correlation
test for Likert scales.
3.1. Sample characteristics from parents/caregivers
A total of 500 respondents joined the parents/caregivers survey,
chosen randomly in 6 intervention areas (Ajangngale, Awangpone,
Cina, Salomekko, Tellusiattingnge and Ulaweng) and two control
subdistricts (Libureng and Bontocani). As shown in Table 1, 64.4%
(n=322) were from intervention areas while 35.6% (n=178) were
from the control. 416 respondents were female (83.2%), while 84
were male (16.8%). Most respondents were mothers or primary
caregivers of adolescents-aged 13-15 years (72.2%, n=361) whilst
20% (n=100) were heads of households. Out of 361 primary care-
givers, 86.3% (n=359) were female respondents whilst 2.4% (n=2)
were male. 38.4% (n=192) had completed elementary school, 21.4%
(n=107) completed junior high school, and 17% (n=85) graduated
from senior high school. For heads of household, 41% (n=205)
completed elementary school, 17.4% (n=87) graduated from junior
high school and 16.2% (n=81) graduated from senior high school.
3.2. Sample characteristics from adolescents
A total of 504 adolescents aged 13-15 years joined the study,
consisting of 24 out-of-school and 480 students from 16 schools
in 8 sub-districts in Bone (6 intervention sub-districts and 2 con-
trol). As shown in Table 2, there were 254 boys (50.4%), and 250
girls (49.6%). Most respondents were in grade IX (224 respondents,
44.4%), the rest were in grade VII and VIII, with most (38.1%) aged
13 years (n=192).
Based on Table 3, several statements related to child marriage
perception differ between parents and adolescents. 25.8% of par-
ents and 26.0% of adolescents agreed that a girl is ready for mar-
riage once she starts menstruating. 29.6% of parents and 33.4% of
adolescents agreed that marrying girls can help protect family hon-
ours/reputation. 29.2% of parents and 33.0% of adolescents agreed
that marrying boys can help protect family honours/reputation.

4
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al. The Lancet Regional Health - Western Pacific 8 (2021) 100103

Table 3
Perception of child marriage for adolescent children and adults (n=1004).

STA A SLA N SLD D STD

Statements n % n % n % n % n % n % n %

A girl is ready for marriage once she starts menstruating.

Parents 9 1.8 106 21.2 14 2.8 31 6.2 33 6.6 301 60.2 4 0.8
Adolescents 25 5.0 33 6.5 73 14.5 44 8.7 53 10.5 192 38.1 53 10.5
Marrying girls can help protect family honours/reputation.
Parents 10 2.0 115 23.0 23 4.6 38 7.6 48 9.6 261 52.2 5 1.0
Adolescents 30 6.0 64 12.7 74 14.7 55 10.9 63 12.5 154 30.6 64 12.7
Marrying boys can help protect family honours/reputation.
Parents 8 1.6 115 23.0 23 4.6 40 8.0 43 8.6 267 53.4 4 0.8
Adolescents 27 5.4 68 13.5 71 14.1 59 11.7 56 11.1 165 32.7 58 11.5
Girls who give birth between 15-18 years are more likely to have a healthy pregnancy/ baby (compared to girls over 18).
Parents 3 0.6 93 18.6 19 3.8 58 11.6 45 9.0 272 54.4 10 2.0
Adolescents 16 3.2 42 8.3 66 13.1 70 13.9 78 15.5 173 34.3 78 15.5
Marrying young girls can help resolve financial problems in the family.
Parents 9 1.8 81 16.2 26 5.2 32 6.4 55 11.0 289 57.8 8 1.6
Adolescents 9 1.8 49 9.7 73 14.5 67 13.3 79 15.7 174 34.5 79 15.7
Marrying young boys can help resolve financial problems in the family.
Parents 6 1.2 79 15.8 31 6.2 31 6.2 53 10.6 292 58.4 8 1.6
Adolescents 22 4.4 47 9.3 69 13.7 75 14.9 53 10.5 169 33.5 69 13.7
Early marriage of girls can help prevent sexual violence, assault, and harassment.
Parents 4 0.8 86 17.2 36 7.2 45 9.0 72 14.4 246 49.2 11 2.2
Adolescents 15 3.0 55 10.9 78 15.5 67 13.3 64 12.7 155 30.8 70 13.9
Early marriage of boys can help prevent sexual violence, assault, and harassment.
Parents 7 1.4 102 20.4 32 6.4 43 8.6 70 14.0 238 47.6 8 1.6
Adolescents 21 4.2 59 11.7 78 15.5 62 12.3 68 13.5 158 31.3 58 11.5
Physical changes in appearance is a sign that a girl is ready for marriage.
Parents 10 2.0 93 18.6 27 5.4 45 9.0 51 10.2 267 53.4 7 1.4
Adolescents 14 2.8 55 10.9 65 12.9 95 18.8 65 12.9 148 29.4 52 10.3
Girls over 18 who are not married are a burden to their families.
Parents 14 2.8 97 19.4 17 3.4 28 5.6 44 8.8 294 58.8 6 1.2
Adolescents 22 4.4 61 12.1 81 16.1 81 16.1 64 12.7 139 27.6 56 11.1
Boys over 18 who are not married are a burden to their families.
Parents 10 2.0 102 20.4 19 3.8 25 5.0 48 9.6 289 57.8 7 1.4
Adolescents 25 5.0 54 10.7 70 13.9 87 17.3 66 13.1 149 19.6 53 10.5
Most adolescent girls prefer to marry before 18.
Parents 9 1.8 54 10.8 7 1.4 41 8.2 50 10.0 328 65.6 11 2.2
Adolescents 18 3.6 48 9.5 65 12.9 70 13.9 58 11.5 156 31.0 89 17.7
Parents expect adolescent girls to become married before the age of 18 years.
Parents 10 2.0 46 9.2 7 1.4 29 5.8 30 6.0 367 73.4 11 2.2
Adolescents 30 6.0 40 7.9 59 11.7 66 13.1 44 8.7 173 34.3 92 18.3
Parents would look down on adolescent girls if they became pregnant before they became married.
Parents 34 6.8 219 43.8 36 7.2 30 6.0 35 7.0 142 28.4 4 0.8
Adolescents 84 13.7 114 22.6 87 17.3 69 13.7 30 6.0 80 15.9 40 7.9
I will obey my parents if they ask me to marry even though I am still at school.
Parents 2 0.4 35 7.0 11 2.2 35 7.0 34 6.8 368 73.6 15 3.0
Adolescents 17 3.4 37 7.3 56 11.1 64 12.7 43 8.5 175 34.7 112 3.4

STA: Strongly Agree, A: Agree, SLA: Slightly Agree, N: Neither disagree nor agree (neutral).
SLD: Slightly Disagree, D: Disagree, STD: Strongly Disagree.

23.0% of parents and 24.6% of adolescents agreed that girls who
give birth between 15-18 years are more likely to have a healthy
pregnancy/ baby (compared to girls over 18). 23.2% of parents and
26% of adolescents agreed that marrying young girls can help re-
solve financial problems in the family. 23.2% of parents and 27.4%
of adolescents agreed that marrying young boys can help resolve
financial problems in the family. 25.2% of parents and 29.4% of
adolescents agreed that early marriage of girls can help prevent
sexual violence, assault, and harassment.
28.2% of parents and 31.4% of adolescents agreed that early
marriage of boys can help prevent sexual violence, assault, and
harassment. 26% of parents and 26.6% of adolescents agreed that
physical changes in appearance are a sign that a girl is ready for
marriage. 25.6% of parents and 32.6% of adolescents agreed that
girls over 18 who are not married are a burden to their fami-
lies. 26.2% of parents and 29.6% of adolescents agreed that boys
over 18 who are not married are a burden to their families. 14.0%
of parents and 26.0% of adolescents agreed that most adolescent
girls prefer to marry before 18. 12.6% of parents and 25.6% of ado-
lescents agreed that parents expect adolescent girls to marry be-
fore the age of 18 years. 57.8% of parents and 53.6% of adolescents
agreed that parents would look down on adolescent girls if they
became pregnant before they marry. 9.6% of parents and 21.8% of
adolescents agreed that they will obey their parents if they asked
them to marry even though still at school.
A Mann Whitney U-Test test results showed a statistically sig-
nificant difference in terms of responses to the statement, “a girl is
ready for marriage once she starts menstruating” between the type
of respondents, p = 0.034, with a mean rank 520.69 for parents
and 484.45 for adolescents (see Table 4). In terms of the statement,
“Girls over 18 who are not married are a burden to their families”,
there was a significant difference between the type of respondents,
p = 0.002, with a mean rank of 475.71 for parents and 529.80 for
adolescents. The other significant differences were found in terms
of the statements, “Boys over 18 who are not married are a bur-
den to their families” (p = 0.009), “Most adolescent girls prefer to
marry before 18” (p=0.011), and “parents expect adolescent girls to
get married before the age of 18 years” (p = 0.002).
Based on Kendall’s Tau-b test results, there was a statistically
significant association in terms of the statement, “Most adolescent
girls prefer to marry before 18 years by type of respondents be-
tween parents and adolescents (p=0.011; r=0.072) (see Table 5).

5
 H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al.
Table 4
Analysis of difference using Mann Whitney U-test.

Type of Respondents (Mean Ranks) U p-

Statements Parents Adolescents Value Value

A girl is ready for marriage once she starts menstruating 520.69 484.45 116,905.000 0.034∗
Marrying girls can help protect family honour/ reputation 500.42 504.57 127,041.000 0.813
Marrying boys can help protect family honour/ reputation. 498.94 506.03 127,778.000 0.685
Girls who give birth between 15-18 years are more likely to have a healthy pregnancy/ baby (compared to girls over 18). 511.56 493.51 121,467.500 0.300
Marrying young girls can help resolve financial problems in the family 506.06 498.97 124,220.500 0.682
Marrying young boys can help resolve financial problems in the family. 492.29 512.63 131,105.000 0.241
Early marriage of girls can help prevent sexual violence, assault, and harassment. 501.66 503.33 126,418.500 0.925
Early marriage of boys can help prevent sexual violence, assault, and harassment. 502.33 502.67 126,085.500 0.985
Physical changes in appearance is a sign that a girl is ready for marriage 487.42 517.46 133,541.000 0.087
Girls over 18 who are not married are a burden to their families 475.71 529.08 139,395.000 0.002∗
Boys over 18 who are not married are a burden to their families. 479.56 525.26 137,470.500 0.009∗
Most adolescent girls prefer to marry before 18. 480.63 524.20 136,935.000 0.011∗
Parents expect adolescent girls to get married before the age of 18 years. 476.80 528.00 138,851.000 0.002∗
Parents would look down on adolescent girls if they get pregnant before they get married 503.21 501.80 125,465.000 0.937
I will obey my parents if they ask me to marry even though I am still at school. 489.39 515.50 132,554.500 0.119
6

Table 5

The Lancet Regional Health - Western Pacific 8 (2021) 100103

Analysis of likert type association using Kendall’s Tau-b test.

Type of respondents Gender Locations

Statements Corr. Coefficient (CC) p -Value CC p Value CC p Value

A girl is ready for marriage once she starts menstruating −0.061 0.034 −0.355 0.000 −0.115 0.000
Girls who give birth between 15-18 years are more likely to have a healthy pregnancy/ baby (compared to girls over 18). −0.030 0.300 −0.076 0.008 −0.101 0.703
Girls over 18 who are not married are a burden to their families 0.087 0.002 −0.018 0.532 −0.011 0.010
Boys over 18 who are not married are a burden to their families. 0.074 0.009 −0.087 0.002 −0.062 0.029
Most adolescent girls prefer to marry before 18. 0.072∗ 0.011 −0.074 0.009 −0.073 0.045
I will obey my parents if they ask me to marry even though I am still at school. 0.045 0.119 −0.130 0.000 −0.057 0.001
∗
p-value <0.05 and r count > r table (r=0.062): significant.
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al. The Lancet Regional Health - Western Pacific 8 (2021) 100103

Based on the Pearson’s Correlation test, there was a statisti-

cally significant association in terms of responses to the statement,
“physical changes in appearance is a sign that a girl is ready for
marriage” by type of respondents between parents and adolescents

p-value
(p=0.0 0 0; r=0.143). There was a statistically significant association

0.244
0.188
0.068

0.073
0.611
0.050

0.000
0.000
0.000
in terms of the statement, “parents expect adolescent girls to get
married before the age of 18 years” by gender between female and
male (p=0.038; r=0.066); by location between intervention and
Pearson’s Correlation

control (p=0.0 0 0; r=0.119). There was a statistically significant as-

sociation in terms of the statement “Parents would look down on
adolescent girls if they get pregnant before they get married” by
Locations

type of respondents between parents and adolescents (p=0.0 0 0;

−0.151
−0.037
−0.042
−0.058

−0.101
−0.062
−0.057
−0.016

0.119∗
r=0.122) (see Table 6).

4. Discussion
p-value

0.126

0.172
0.937
0.170
0.058

0.001
0.038
0.002

0.000

4.1. Support for child marriage still high because of pride

Pearson’s Correlation

This study found that 29.6% of parents and 33.4% of adolescents

strongly agreed/agreed/slightly agreed that marrying girls can help
protect family honours /reputation. The perception of the benefits
of child marriage in terms of protecting family honours /reputation
−0.155
−0.043

−0.048

−0.104
−0.060

−0.096
−0.043
−0.002
Gender

0.066∗

was significantly higher among adolescents than those of parents.

This is because the mind frames of adolescents that marriage will
protect the honours of the family as future successors. So, when
p-value

a marriage is not held even though it has been planned regard-

0.559
0.454
0.916

0.585
0.762
0.097

0.868
0.000

0.000

less of the age of the child, the marriage must still be conducted
to protect the family’s honours because it has been planned. In
Pearson’s Correlation

South Sulawesi, A study reported the practice of child marriage

Type of respondents

among Buginese and Makassarese to be socially and culturally sup-

ported. People often believe that the sooner women are married,
the better their economic and financial position will be, as well
as the family’s honor [12]. However, when women marry late or
0.143∗

0.122∗
0.018
0.024
0.003
0.052
0.017
0.010

0.005

stay single, it is said their prosperity and luck are ‘closed and late’
which means that it can bring shame to family honours. Often the
community blame women as being ‘poor’ and have negative per-
Parents would look down on adolescent girls if they get pregnant before they get married

ceptions of them being unmarried. As most Buginese and Makas-

sarese are Muslim, they often believe that child marriage is jus-
Early marriage of boys can help prevent sexual violence, assault, and harassment.
Early marriage of girls can help prevent sexual violence, assault, and harassment.

tifiable because there are no clear Islamic teachings either in the

Quran or Hadith that dictate the minimum age of marriage, and
it is merely on physical and biological aspects such as aqil baligh
Parents expect adolescent girls to get married before the age of 18 years.
Physical changes in appearance is a sign that a girl is ready for marriage
Marrying a boy young can help resolve financial problems in the family.

(coming of age). They tend to seek normative religious-based texts

Marrying girl young can help resolve financial problems in the family

which eventually claim the truth based on Islamic teaching. For

Analysis of Likert scale association using Pearson’s Correlation test.

them, women and men can marry if they have already achieved
aqil baligh, without considering their age [12].
p-value <0.05 and r count > r table (r=0.062): significant.
Marrying boys can help protect family honour/ reputation.
Marrying girls can help protect family honour/reputation

4.2. Support for child marriage still high because of economic factors

Marriage is sometimes used as a means to rise out of poverty

and into higher social status. Around 23.2% of parents and 26.0% of
adolescents strongly agreed/agreed/slightly agreed that marrying a
girl young can help resolve financial problems in the family; 25.6%
of parents and 32.6% of adolescents strongly agreed/agreed/slightly
agreed that girls over 18 who are not married are a burden to
their families. Different perceptions related to economic problems
can lead to stronger adolescent perceptions towards the benefits of
child marriage than parents. Some adolescents see aspects of mar-
riage as helping to improve the economic life of the married cou-
ple or child. The perception of raising the standard of living and
Statements

solving economic problems carries more benefits than the negative

consequences of marrying underage and illegally. The amount of
Table 6

dowry given, and debt incurred, can also contribute to child mar-
∗

riage.
One study found that people with low incomes in Vietnam tend
to be younger than people in middle- and higher-income families
[13]. A study in India reported that literacy and socio-economic

7
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al.
status of the mother and her parents were a major determinant
in deciding the age at marriage [8]. A study also reported that
poverty and poor education are underlying causes of child mar-
riage, which is usually against the will of girls who desire to be
educated [14]. Moreover, findings from quantitative studies in In-
donesia also revealed that marriage is sometimes used as a way
out of poverty [15]. This indicates that women’s education, work
status before marriage, husband’s education, and current residence
are the predictors for early marriage in Java, with education as the
strongest. Women who are married at a younger age also mostly
live in poverty [14]. These negative effects will often also be ex-
perienced by their children and can continue in future genera-
tions. However, the Bureau of Statistics also reported the child’s
age at marriage is strongly associated with poverty, however, a
high prevalence of child marriages was also found in provinces
with low poverty levels. This might suggest that poverty is also
used as the reason given for child marriage, but motivations are
more complicated [2].
4.3. Child marriage and unwanted pregnancy
Around 57.8% of parents and 53.6% of adolescents strongly
agreed/agreed/slightly agreed that parents would look down on
adolescent girls if they became pregnant before they marry. There
are differences in perception related to unwanted pregnancy, with
stronger support for child marriage as a solution from parents than
adolescents. Bugis culture encompasses a belief in the importance
of ‘siri’ (shame), which includes a strong social norm that it is
shameful if a child is pregnant outside of marriage so she must be
married even though she’s underage. Parents believe this is prefer-
able to the family bearing the shame. Child marriage is a relatively
common phenomenon throughout Indonesia, with practices such
as covering the shame of extra-marital sexual relations, manipu-
lating age and wedding dates, falsifying marriage dispensation, as
well as handling teenage pregnancy by arranging a marriage, are
found throughout the country, including in non-Muslim areas [16].
One commonly hypothesised reason for child marriage in the
United States is the so-called shotgun wedding, entered into under
pressure from family members or others who aim to avoid per-
ceived stigma resulting from premarital sexual activity and preg-
nancy [17]. A study in fifteen countries, including Indonesia, found
that child marriage is associated, among other factors, with lower
age at first birth, higher fertility, lower contraceptive use, and
higher risks of unplanned pregnancies and pregnancy termination
[18]. Children’s unwanted pregnancy and early marriage are still
quite high in Indonesia. The parent’s role is an important factor
in a child’s unwanted pregnancy and early marriage. Permissive
parents (those whose children married underage) had 2.18 times
greater unwanted pregnancies compared to less permissive parents
when adjusted for other variables. Of the permissive parents, 68.3%
were from strongly religious families, and 25.0% believed the func-
tion of the family is a reproduction, which was significantly asso-
ciated with unwanted pregnancies. A large number of unwanted
pregnancies and early marriages are associated with parental per-
missiveness, religiosity, and belief in the reproductive function of
families [19].
4.4. Menstruation, puberty and child marriage
Around 25.8% of parents and 26.0% of adolescents strongly
agreed/agreed/slightly agreed that a girl is ready for marriage once
she starts menstruating, 26.0% of parents and 26.6% of adolescents
agreed to physical changes in appearance are a sign that a girl is
ready for marriage. Perceptions about menstruation and puberty
as a contributor to child marriage are stronger in adolescents than
parents. This is due to observations by adolescents that children
8
The Lancet Regional Health - Western Pacific 8 (2021) 100103
who legally are not ready to marry (aged under 19 years), actually
can marry because the signs of puberty, especially menstruation,
indicate their readiness. This perception towards physical change
and menstruation was still strong among parents and adolescents.
Considering the practices of the Musgum people in Cameroon
and Chad, participants in one study stressed the importance of
physical preparedness for deciding whether a girl is ready for mar-
riage. One older man, for instance, said: ‘It is when a girl already
has breasts that she can be sent for marriage’. Another older man
confirmed: ‘Yes, she is 15 years old. So, she can get married normally.
But if she has a small body and is without breasts, she can delay
the wedding’. One young man explained: “Among the Musgum, what
matters is when the girl has her first period. The girl may see her first
menstruation when she’s 13; then she can get married; age depends
on the body of the girl” [20].
A legal case in India featured a man who had advocated for
lowering the marriageable age of girls, saying a man aged 30 years
should be able to marry a 12 years old girl who “charms his heart”,
and a man of 24 years should be able to marry a girl eight years
old. He also said girls should be married before they reach pu-
berty, if they marry after first menstruation, they become impure
and parents are likely to go to hell. In fear of going to hell, par-
ents started arranging marriage for their daughters before age ten,
sometimes at four or five, and some even went to the extreme of
getting them married in the cradle [21]. Another study from In-
dia reported that girls in their community have their first period
between the ages of ten and twelve. For those living in the vil-
lage, streeachar (feminine rituals) were performed to mark a girl’s
puberty and menarche. While these rituals have been changed or
lost with modernisation, the onset of menstruation is considered
a ‘warning’ signal to the girl’s parents. As soon as she attains pu-
berty, the elders begin to alert her parents to start looking for a
groom, to protect her virginity and honours [22].
4.5. Child marriage and sexual harassment
Around 25.2% of parents and 29.4% of adolescents strongly
agreed/agreed/slightly agreed that early marriage of girls can help
prevent sexual violence, assault, and harassment. The perception of
child marriage as protection against sexual harassment is stronger
in adolescents than in parents. Fed by the media portrayal of the
frequency and uncontrolled incidence of rape and other sexual vi-
olence, adolescents believe that it will happen to them. These ado-
lescents believe that marriage, even underage, is better than deal-
ing with continuous violence and harassment. By extension, girls
attain sexual maturity, their vulnerability to sexual violence rises,
along with parental apprehension about their safety. This is espe-
cially apparent in traditional and poor communities where girls’
roles are often expected to be that of mothers and wives. Parents
who marry their children before they reach the legal age are typ-
ically motivated by social and sexual norms (often attaching low
value to daughters), as well as poverty or humanitarian crises. Con-
fronted with social pressure and family hardship, they may seek in
marriage a form of protection to shield their children from destitu-
tion, household food insecurity, and, ultimately, sexual harassment
[23].
However, the evidence shows girls who marry below 18 years
are more likely to experience domestic violence than their peers
who marry later. For example, in Peru, where more than half
of women report having experienced physical or sexual violence,
child marriage has been found to increase a woman’s chances of
being abused [24]. Girls who marry early are more likely to believe
that a man is sometimes justified in beating his wife than women
who marry later. For example, in Kenya, 36% of girls married before
18 believe that a man is sometimes justified in beating his wife,
compared to 20% of married women [25]. Girls with low bargain-
H.R. Wibowo, M. Ratnaningsih, N.J. Goodwin et al.
ing power in the household are more likely to experience violence
by an intimate partner. Women with low levels of education and
adolescents ages 15 to 19 are at higher risk of violence than better
educated or older women [24]. Ending child marriage must be a
priority in the global effort to end violence against women.
5. Conclusion
The prevalence of positive perceptions of the benefits of child
marriage is still high among both parents and adolescents in Bone.
However, the study found how they differed, for example, the per-
ception of the benefits of child marriage towards family honour
and reputation was stronger among adolescents than parents. The
responses to the economic benefits of child marriage also highlight
this difference in perception between parents and adolescents. For
parents, who may be more sensitive to economic issues, marrying
girls at a young age was seen as a way to resolve financial prob-
lems and avoiding the burden of those aged over 18 years who
are not married. Marriage is still seen as a way out of poverty
and pulls young people towards its promises of a better life. The
power of shame around unwanted pregnancy contributes to the
additional push to convince parents to seek marriage. Perceptions
of a girl’s readiness based on signs of puberty provide the be-
haviour trigger for action. Beliefs in the benefits of child marriage
as a way to prevent sexual violence provide additional impetus, es-
pecially for fearful girls. Comprehensive interventions based on be-
havioural science and cultural understanding are needed to provide
high-quality services and communicate the benefits of preventing
child marriage in Indonesia.
Declaration of Competing Interest
We declare no competing interests. The authors whose names
are listed immediately below certify that they have no affiliations
with or involvement in any organisation or entity with any finan-
cial interest or non-financial interest in the subject matter or ma-
terials discussed in this manuscript. Nicholas Goodwin has a com-
mercial contract between UNICEF and Tulodo.
Acknowledgements
We thank to Tulodo team (Ridwan as Project Officer in Bone,
South Sulawesi for supporting data collection, Yulida Pangastuti
as the Gender Specialist for the baseline study, and Ratnakanya
Hadyani as Communication Officer for creating communication
products from the baseline study) and UNICEF Indonesia (Reza
Hendrawan, Annisa Elok Budiyani, Amelia Tristiana, Hendriyadi
Daeng Sila, Hengky Widjaja, Ticiana Garcia-Tapia, Tanti Kosmiyati
Kostaman, Husnul Nh and Amanda Bissex), enumerators, local gov-
ernment, LPP Bone, community leaders, religious leaders, religious
organisations, NGOs, other UNICEF partners, and all study partici-
pants in Bone, South Sulawesi.
Contributors
The first authors drafted the report, which all authors reviewed
and approved. All contributions, including research plans, data
analysis, and research reports, were made by the Tulodo Indone-
sia team (led by Heribertus Rinto Wibowo, Muliani Ratnaningsih,
and Nicholas J. Goodwin) and supported by UNICEF team (Derry
Fahrizal Ulum and Emilie Minnick).
Data sharing
The full baseline study report with detailed data is available
with approval from UNICEF Indonesia.
The Lancet Regional Health - Western Pacific 8 (2021) 100103
Supplementary materials
Supplementary material associated with this article can be
found, in the online version, at doi:10.1016/j.lanwpc.2021.100103.
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